In the past few years, Health Sciences North/Horizon Santé-Nord (HSN) in Greater Sudbury has struggled with some of the longest emergency department wait times (ED) in Ontario. Now, HSN is being commended for the performance of its ED.
The Ontario Ministry of Health and Long-Term Care has congratulated HSN for achieving the best improvement in ED wait times among teaching hospitals in Ontario. In 2013/14, HSN’s overall 90th percentille ED Length of Stay (LOS) was 9.8 hours, a two-hour improvement from the year before.
The MOHLTC also says HSN’s overall 90th percentile LOS last year was 1.4 hours shorter than the average of 11.2 hours for all teaching hospitals in Ontario.
These improvements were achieved at a time when ED visits actually jumped by 6000 to approximately 66,000 patients.
“It’s great news that the ED team is being recognized for all the hard work and efforts put into improving wait times,” says Dr. Rob Lepage, an ED physician and Medical Director of HSN’s Emergency Department.
Dr. Lepage points to a number of initiatives that have been launched to improve the ED LOS. They include a “See and Treat” area for patients with less serious conditions, an Acute Observation area for patients with more urgent health concerns, and daily huddles where ED staff discuss the patient load and how best to meet any challenges that arise.
One of the most dramatic improvements in LOS has occurred in the wait for a hospital bed for patients admitted from the ED. Last year that time was 21.7 hours, compared to 38.7 hours the year before.
This is an achievement not only for the ED, but for HSN’s entire clinical program and the hospital’s community-based health-care partners.
“ED wait times are affected by how safely and smoothly we can transition patients from the ED to an inpatient floor and then back into the community, and how well we can then avoid readmissions to the ED or a hospital bed,” says David McNeil, HSN’s Vice President of Clinical Programs and Chief Nursing Officer. “Our clinical programs and community partners have done a wonderful job of transitioning patients back home safely. There is always room for improvement, but we do feel we’re heading in the right direction.”
In the past tw0 years, HSN has implemented a number of measures across its clinical programs to improve care and patient flow.
The ED Outreach program has been expanded, whereby an ED clinician visits participating long-term care homes to treat minor conditions so patients do not have to visit the ED. There are nurses in the ED to deal specifically with patients arriving by ambulance or who have mental health care needs. HSN has relocated its mental health Crisis Intervention Service to downtown Sudbury and expanded the hours of operation, to provide appropriate care at a time and place more convenient for clients, resulting in much fewer visits to the ED.
A special multidisciplinary COACH (Care of Older Adults with Compromised Health) team has been created for seniors admitted to hospital. Led by leading Canadian geriatrician Dr. Janet McElhaney, the COACH team uses best practices to prevent further frailty, reduce the length of hospital stay, and reduce or avoid hospital readmissions. HSN has also launched a new outpatient service, the Short Term Assessment and Treatment (STAT) program, which provides frail seniors with a number of services in one location.
HSN is also working with the North East Community Care Access Centre to implement a system of in-home, follow-up visits within 48 hours of frail seniors being discharged from hospital.
HSN’s Heart Failure Infusion Clinic has dramatically reduced ED visits and hospital admissions for patients with Congestive Heart Failure. HSN`s Diabetes Care Service is also serving as a one-stop location for all outpatient diabetes care, to prevent or reduce ED visits and hospital admissions due to complications from diabetes. HSN`s surgical program has expanded its number of minimally invasive procedures, leading to quicker recovery times and fewer days spent in hospital.
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It is this process of constant evaluation and improvement that Dr. Rob Lepage says will continue. The ED is planning to expand the Acute Observation area, and is also looking at scheduling a back-up physician on days when the ED is particularly busy, for example after long weekends. “We won’t be satisfied until the ED LOS is reduced further,” adds Dr. Lepage. “We want to keep working to give our patients a better experience in the ED.”